Disciplining Calif. doctors is a long process

Board spokeswoman Candis Cohen noted the high burden of proof required to take a doctor's license makes prosecutions difficult but said speeding the enforcement process is a priority. Cohen, who retired as planned shortly after being interviewed, declined to comment further, saying additional information can be found in board publications and through the California Department of Consumer Affairs that oversees it.

The board is comprised of nine doctors and six non-physicians. Its $52 million budget comes from fees collected from the state's 122,000 doctors and is used to operate the enforcement program.

When complaint is received, it's turned over to a board controlled unit for vetting. If the complaint is deemed worthy of further inquiry, an investigator is assigned and the attorney general's office, which handles the prosecution, is notified. The investigator later turns over findings to the attorney general's office, which decides if there's enough evidence to go after a doctor's license.

There was enough in the Kamrava case. When his hearing ends, an administrative law judge will make a recommendation to the board, which then will determine whether to take his license.

Complaints about the lengthy process are not new. About 20 years ago, a scandal erupted when it was found board officials secretly ordered the dismissal or destruction of hundreds of complaints to reduce a 1,100-case backlog that was being criticized by legislators. Outcry from consumer advocates and pressure from then-Gov. Pete Wilson's office forced the resignation of board director Ken Wagstaff.

The glacial pace of doctor discipline continued, however, and in 2004 the state appointed lawyer Julie Fellmeth to monitor the process. She helped author Figueroa's legislation, which sought to fix "the inefficiency inherent in the fragmented relationship between the Medical Board's investigators and the Attorney General's prosecutors," Fellmeth wrote in one of her reports.

The problem, Fellmeth said, was poor communication between investigators and prosecutors. The investigators would complete their work and hand over a file to prosecutors, who often had many questions of their own. Investigators would then go back into the field seeking answers, causing more delays.

The 2005 legislation called for investigators to move within the attorney general's office. The bill was endorsed by the board and the attorney general, the California Medical Association - the largest doctors' group in the state - and 10 former medical board presidents.

But a day before the veto deadline, Gov. Arnold Schwarzenegger insisted on removing the provision.

"We weren't given an explanation, we were just told you have 24 hours in which to amend this bill, or the governor's probably not going to sign it," said Fellmeth, now administrative director for the Center for Public Interest Law at the University of San Diego.

Since the bill also contained a provision that continued the medical board's existence beyond its sunset date, a veto could have meant dissolution. Schwarzenegger got his way.

"We should have called his bluff and put it on his desk," Fellmeth said.

Schwarzenegger spokesman Matt Connelly defended the move, saying it could have created a staffing issue for the attorney general. He would not elaborate.